The overwhelming responsibility we have to the welfare of our patients far exceeds the confidence we have in our scientific method. As a psychiatrist, I treat soldiers and veterans with brain conditions and injuries from combat. As a retired army general, I advised the most senior leaders of the Department of Defense about the consequences of more than 10 years of war.
I served during the Vietnam War and watched my fellow soldiers return to civilian life, many suffering with the post-traumatic stress. It took my profession too long to recognize the diagnosis. And, it also took too long to acknowledge the effects of Agent Orange. These mistakes cost thousands of lives and ruined even more.
Less than 50 percent of soldiers are helped today with traditional treatments. But, mainstream medicine is often reluctant to try innovative approaches, even when the technologies are tested and the risk is infinitesimal. Military leaders manage risk all the time knowing that their business is "life and death." It is smart and humane to "take risk" when it is low in the face of suffering and the assurance of benefit is reasonable.
Despite the daily suicides, the shootings, all the facts and figures that are now tragically cliché, our government institutions remain in a state of surreal paralysis. Soldiers do not have lobbyists. Expensive pieces of military hardware, pharmaceutical drugs -- they have lobbyists. While less than half of soldiers and veterans are being helped by medications, the FDA, the VA and the DoD have been unwilling to try promising treatments even when the risk is low. Soldier mental health care calls for moral commitment and social justice -- not just responsible scientific debate.
Let me tell you a true story that in our age has become cliché. After serving his second tour in Iraq in 2008, a 34-year-old Reserve Army sergeant returned home to insomnia, anxiety, depression and persistent headaches, the latter the result of untreated concussions sustained from IED blasts. In an effort to deal with these "invisible wounds," he turned to illicit drugs and alcohol. At the insistence of his father, the soldier pursued the usual treatments readily available to him. He saw a series of psychiatrists and was prescribed medications for his depression and sleep disturbance, but to no avail. His issues persisted. His mood improved only when he was able to abstain from drugs and alcohol, but he always relapsed after a few weeks. At the lowest points of his downward spiral, he became suicidal. Every line of traditional treatment seemed to lead to a dead end.
His father reached out to my clinic. We apply discoveries and technologies from the laboratory safely and efficiently to clinical practice. In Silicon Valley, we'd be called an incubator. The soldier decided to take a risk and agreed to follow an integrated, multi-pronged approach that utilized both traditional and non-traditional interventions, including a course of cranial electrostimulation therapy (CES) to treat his insomnia, anxiety, depression and withdrawal symptoms, and hyperbaric oxygen to alleviate his headaches resulting from the IED concussions. I have been using hyperbaric chambers for many years, but had only learned of cranial electrotherapy stimulation therapy in 2009 -- decades after it had been cleared by the FDA and subsequently lost in a marketplace dominated by drug marketing.
After five days, the sergeant's sleep began to improve. After several more days, his withdrawal symptoms had profoundly diminished. After 10 sessions of hyperbaric oxygen at 1.5 atmospheres, his severe headaches were relieved. By the end of the course, he experienced near remission of his sleep disturbance and depressed mood. He was no longer suicidal.
Eventually, the sergeant went on to complete the substance rehabilitation program and was able to attend college and work. He is currently engaged in psychotherapy and using CES device to keep anxiety, depression and sleep disturbance at bay.
This case illustrates the difficulty and frustrations facing many soldiers today in search of timely and effective care for their invisible wounds. The VA does not cover the cost of cranial electrostimulation therapy (CES). It considers it an "experimental" therapy, despite the fact it causes none of the serious side effects of drugs and costs a fraction of annual prescriptions. The FDA has for years withheld reclassifying these devices as Class I or Class II medical devices, which would allow private insurance companies to reimburse for them and no longer deem experimental. Just a few weeks ago, a 200-person sleep study I submitted to the Army to further study cranial electrostimulation therapy (CES) met with so many bureaucratic obstacles and objections over the underlying science of CES that it has been delayed to at least 2014, I've been told. Hundreds of soldiers will take their own lives between now and then, and billions of dollars will be spent on traditional therapies that are not solving the problems we face.
The injured veterans are the sad legacy of a long war and a public health problem. There has to be a better way to help them before their lives spiral down and too many lose hope and either commit suicide or end up homeless. These men and women deserve treatment now when they need it. It is available if the government and medical professions commit to smartly managing the risk and benefit of promising treatments.